Eating disorders (young people)

The beginning of an eating disorder

People described how their problems often developed gradually over a few years. Sometimes the development was slow with “on/off” periods and then something would trigger a rapid deterioration. Often people didn’t realise things were getting out of hand and the eating disorder developed “before I knew it”. David said his bulimia nervosa developed over a period of a couple years; “it wasn’t something that I really necessarily noticed; it just started to creep on”. 

“When you’ve been doing that for such a long time, it just becomes habit and routine and you lose sight of why you did it in the first place.” Steph

An eating disorder could also develop quickly, over a course of a few months. Young people we talked with often recalled specific times; holidays, school trips, arguments at school, home or with friends that had happened just before things “flipped over”. Once the eating disorder had “kicked in” in full, people described how things quickly “spiralled out of control”. Soon they realised they had become engrossed in an obsessive routine of behaviours that “took on a life of its own” and which could include:

• restricting or limiting the amount of food they ate 
• bingeing or eating excessive amounts
• purging to get rid of food they had eaten from their bodies

Steph remembers making a decision to start losing weight when she was on holiday. Things...

Steph remembers making a decision to start losing weight when she was on holiday. Things...

Age at interview: 23
Sex: Female
Age at diagnosis: 14
SHOW TEXT VERSION
PRINT TRANSCRIPT

I first started losing weight when I was thirteen and I remember it very well. I was on holiday, we were on holiday in Switzerland visiting friends, and I remember saying to myself, “Now when I get back from my holiday, I’m going to lose some weight.” So I did that because I was, I was quite, you know, a chubby child so I had weight to lose without anybody noticing, and when I first started losing weight people just thought I was losing my puppy fat and thought nothing of it, and it wasn’t until, it just spiralled out of control really and I became very driven and very determined just to keep losing weight, and eat as little as possible and exercise as much as possible. And it was when I was fourteen, my sister said to my Mum, “Do you realise Stephanie hasn’t eaten anything today?” You know, it came to dinner time, I didn’t want my dinner either and my Mum thought, “Neither she has”.

Everything changed for Roberto when he moved to study in the United States. The culture was very...

Text only
Read below

Everything changed for Roberto when he moved to study in the United States. The culture was very...

Age at interview: 20
Sex: Male
HIDE TEXT
PRINT TRANSCRIPT
Well I guess like everything started when I went to study abroad in the States. I went after High School when I was probably 18 years old. And well before then I’d never had any issues like with eating or anything at all I mean. And then when I got there I realised like the culture was pretty different and like we have these, well a lot of people have this stereotype about like having that freshman 15, like maybe you have that here in the UK. But it means the first year you go to college or university you gain 15lbs like just, that’s about it like and. So well for me it was actually a big thing like cos well not a big thing at that moment but because first I wasn’t used to American food, and we’ve got, well I, like you see in the movies and everywhere these stereotype that American food is very fatty and very unhealthy.
 
So that was part of the reason. Then actually the other thing was that a lot of people in America were, I’ve always been like a very athletic person. I loved to play football, tennis, many sports in my home country, but when I went to America I realised that people, well they are very, they tend to exercise a lot, but they’re kind of in another way. I mean like they tend to run or go to the gym a lot, so that was something that I’d actually never think of doing it when I was home so I was like well maybe I should try it because otherwise I know I’m gonna gain some pounds and something.
 
So that was like the first two things that stuck in my mind. Like the unhealthy food and people like around me exercising all the time, that kind of stuff. So I, in some sense I think that I was going, I had to follow their, their routine. So yeah so well, that was like my, well probably I started thinking that way after my first semester, my first year at Uni. And from then on everything was up like, well I started like doing exercise, I started going to the gym, started to eating better like actually care I actually liked to see what I was eating and that kind of stuff. 
 

“Once you start doing a lot of things [restricting and exercise] it became easier and easier to fall into habits.” Chloe

Different eating disorders could have different early signs and forms. Something that started as restricting food intake could turn into bingeing and purging, and the other way around. Patterns of eating usually went hand in hand with exercise. People with anorexia nervosa often said how it had started off as just “a health kick”; eating more healthily, or starting a diet to lose a bit of weight. They saw friends or family members dieting and it seemed to be “what everybody did”. Initially people cut out or ate less of particular foods (for example high calorie foods), then they cut out foods or food groups (for example fats or carbohydrates) completely and started to skip meals. The view of what was enough/a lot of food could become distorted.

“I think I just got to a point where I kind of flipped over and then it was literally an apple is too much.” Sara

Some said they went for days without eating, or never ate at school, saving up their lunch money. 

Zoe started developing anorexia nervosa after taking her GCSEs. She began controlling her eating,...

Zoe started developing anorexia nervosa after taking her GCSEs. She began controlling her eating,...

Age at interview: 23
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
The first thing that I can really remember in terms of eating going a bit wrong was I’d just finished my GCSE exams, so this was when I was sixteen, and shortly after that well, after finishing we had a very long summer holiday, longer than I’d ever had before because the exams ended and until sixth form started there was quite a long break. And during that time, I was well, looking back I can see it now but at the time I wasn’t really aware, that I sort of starting engaging in a lot more exercise than I would usually do.
 
And also I started cutting back on what I was eating and I think it was it was because I felt like I’d put on maybe a bit of weight over the exam period, which I don’t know whether I had or not. I mean probably had because I was just sitting revising. And over the summer months it sort of that sort of pattern increased so I was gradually doing more and more exercises and eating less and less.
 
And by the time I started six form in the following September I had lost a substantial amount of weight and I think when I got to six form it was a very different structure to what I was used to. There was no, well, not many lessons. There was a lot of sort of study periods and I think that sort of made me feel perhaps out of control and so, because of that, I started, you know, I was really started increasing the exercise even more, restrict, controlling what I was eating even more to kind of make up for the lack of control I felt I had over my sort of school work.
 
And at the time I had a boyfriend, who noted that things weren’t right. I’d lost a lot of weight. I was obviously, he could tell I wasn’t eating and I was engaged in quite a lot of exercise and I was not myself. I was very miserable, I felt I was quite tearful. I was really focusing very much more even more than usual on my studies. So really just studying the whole time. 
 
So eating disorder was really taking over and I was getting weaker and weaker and less and less like myself. I was still going to school and really focussing on my studying and my parents didn’t know what to do. 
 

When Eva was 14, she started limiting what she ate, recorded everything that she ate and drank...

When Eva was 14, she started limiting what she ate, recorded everything that she ate and drank...

Age at interview: 17
Sex: Female
Age at diagnosis: 14
SHOW TEXT VERSION
PRINT TRANSCRIPT
Shortly after like my fourteenth birthday I was wasn’t fitting in very well with my friendship group at school, and I felt very academically pressured in the school that I was in, like I’d always try really hard in my school work, but I never felt as though it was good as my friends’ work and I started to feel like quite competitive about that. But it was getting me down that I wasn’t doing as well as them, and especially as I wasn’t fitting in and it felt very lonely. 
 
In, like I was best friends with a girl, but we stopped being friends and a new girl came to the school and took my place as this girl’s best friend. And she was like quite skinny and she was really clever, so I started to feel like maybe if I’m more like her people will like me more because she was popular and everything.
 
So I got really interested in diets and stuff and I started to like count how much fat I was eating. But it wasn’t really working and I was getting more and more unhappy. So I started going on the internet and found all thinspiration sites and stuff and I started to use them a lot. I signed up to lots of them and would talk to other people on them.
 
And from there I just got really obsessed with what I was eating and I’d start to write, because on some of the websites it would say things like, write down what you’re eating. So you could like cut out things the next day. So I used to obsessively record everything that I ate and drank, even when it was just things like water.
 
And I’d started to halve it, and it got to the point where I was throwing my lunch away at school and like my Mum obviously didn’t know that, but she started to click on that I wasn’t eating all my meals and stuff. So she took me to the doctors, and the doctor said to me that I had anorexia but my Mum didn’t tell the appointment was for like to getting a diagnosis for that, she told me it was because I’d been a bit ill, so I just went along with it.

People could develop “fear foods”; foods they became scared of and wouldn’t eat at all for fear of immediate weight gain. Weight gain was also associated with being unhappy, lazy or ‘a failure’. Food and eating were attached with deep-rooted emotions and meanings, and restricting food could become a form of punishment. (For more see ‘What is anorexia nervosa?’).

Bulimia nervosa often started off as a one-off incident of making oneself sick, as an emotional response to an argument, a feeling of having failed at something (for example in school), or after a binge. A couple of people with bulimia nervosa said that since they were little they had always been sick easily, and involuntarily. Elene had very early memories of being as young as eight and making herself sick and Sam initially believed that being sick would make him feel better in the same way as when he had a stomach bug.

David’s bulimia nervosa started as a “one off”, making himself sick after eating a takeaway....

David’s bulimia nervosa started as a “one off”, making himself sick after eating a takeaway....

Age at interview: 22
Sex: Male
Age at diagnosis: 19
SHOW TEXT VERSION
PRINT TRANSCRIPT
I remember just eating a massive Chinese on my own, purely on my own. And I’d had, you know, I just, I’d got to the point where I sort of was rewarding myself I guess for having lost lots of weight, so I went, “Okay I’m gonna have a Chinese,” and I didn’t just have a Chinese, I had about a three person portion of Chinese. And then felt so horrendously guilty for doing it and I remember doing it, I still remember that, that evening. Just what, “I wonder if I made myself sick if it’s gonna make a difference?”
 
So I did, and it was a purely a one off. I then went back into the, just eating, I say healthily, dieting, carrying on. And I didn’t do it again for, for a long time. And then I wasn’t getting the comments again I guess, or I wasn’t losing weight as much as I wanted to and so it happened again. And, and somehow, I don’t, I can’t even pinpoint when it became a habit that was happening at all the time, on a daily basis. I can’t remember when that started. It, I just remember suddenly realising one day, this is happening everyday now, it’s, this is a little out of control. It’s not just a, I’ve eaten lots and it’s a one-off. This is, I’ve eaten hardly anything all day and yet I still want to do it, which is obviously an unhealthy aspect of it.
 
And soon before I guess I knew it became a habit. A habit that my parents worked quite a lot and aren’t often home, so it wasn’t anything hard for me to hide. Again at work, I worked for a very lenient company where if I disappeared off to a toilet, you know, so on for a little period of time it wasn’t really noticed. So that it just became an essential part of my life and at the age of 19 it, it was just part of my life. I would eat a lot of food and then I would make myself sick. To the point where I stopped the dieting. It was having the effect I wanted it to so I was eating as I pleased, gorging on food if I wanted to and then obviously purging myself in the evenings or at lunchtimes at work.
 
And it did after I’d say about a year, you know I was still 19, probably coming onto 20, that’s when I first realised it had become a part of my life and I remember it scaring me. And thinking actually this isn’t normal. This isn’t actually what other people do. And then kind of wanting to, to talk about it, but not wanting anyone close to me, friends or family, knowing what I was doing or what was happening, you know, they, they were congratulating me for weight loss which as far as they were concerned was down to me dieting and exercising, not down to the real reason. 
 

At 13, Rebekah tried different diets as she felt everyone around her was dieting. Soon she was...

At 13, Rebekah tried different diets as she felt everyone around her was dieting. Soon she was...

Age at interview: 18
Sex: Female
Age at diagnosis: 16
SHOW TEXT VERSION
PRINT TRANSCRIPT
When I got to about 13 I kind of like discovered the internet, and then was all into the whole, dieting sort of phase. I was, my friends, everyone around me at school at that age, everyone wants to lose a bit of weight, everyone’s so interested in the media, interested in celebrities, they, they’re losing all that weight, they want to lose it, and I started all these fad diets, all these silly little things and I came a bit involved with some stuff on the internet, the whole pro-anorexia sort of thing, and that kind of just took me into the grips of my eating disorder.
 
I started binging and purging and just restricting my calorie intake, and it got to a point where I just, I couldn’t go into school because I was so lethargic, I was so, I was just so down, and I just kind of spent all my days pretty much on the internet, not focussing on my school work, and it was, it just became this whole big obsession.
 

Obsessions around food, weight and exercise were also common. People developed different habits such as calorie counting, obsessive weighing many times a day, obsessive exercise and recording and charting everything. Some didn’t need to write any of it down as it was all in their head. Trying to cook meals with as few calories as possible could result to trips to supermarket lasting for hours, carefully checking and comparing food labels. 

Katherine was obsessively checking food labels, controlling what food her parents gave her and...

Katherine was obsessively checking food labels, controlling what food her parents gave her and...

Age at interview: 19
Sex: Female
Age at diagnosis: 11
SHOW TEXT VERSION
PRINT TRANSCRIPT
Then increasingly started checking fat content, not really concerned with calories, but obsessively checking fat content, saturated fat contents on the back of packets. Anything that I was eating, components of what might be going into dinners and things, and so this is all kind of in, towards the end of year 6. 
 
And lost a lot of weight over that, and the kind of interim change between primary school and secondary school. And then it just sort of continued really, I just got more and more acute with what I was, what I was eating and checking packets. Checking labels, making sure, getting very controlling over what my parents were giving me, and going to the supermarkets with them, all that kind of thing.
 
And then it just, it just progressed really on a very restrictive path. So you know I’d just cut out all sweet foods and think… I tried to eliminate basically every possible element of fat in my diet so I would just have the bare minimum. And that was, it was really from kind of, it was sort of year 8 and 9 where it got really bad.
 

Exercise patterns would change; people started exercising more or exercising alone and/or in secret, or, alternatively, some stopped exercising completely. Exercise changed from something that was fun and enjoyable to just a method for losing weight. Roberto had been sporty all his life but after he moved to the United States to study, his motivations for exercising changed. Sport was no longer about enjoyment and wellbeing, it became a response to food; a form of self-management'

“It was a very new thing ‘cos before any of my friends ran or went to the gym like, we do sports but we did it to have fun, not to burn calories. So that was the main difference.” Roberto

People often didn’t want others to find out about their changing habits around eating and exercise and described how they became secretive. (For more see ‘Secrecy and eating disorders’).

As the eating disorder escalated, other behaviour and emotions became more intense. For example, people could feel more isolated or unhappy, or develop obsessions in other areas of life such as school work. They could experience depression and low moods, overwhelming feelings of guilt, anger and upset and want to harm or punish themselves.

Andrew’s eating disorder started by involuntary vomiting. He started obsessing about food,...

Andrew’s eating disorder started by involuntary vomiting. He started obsessing about food,...

Age at interview: 19
Sex: Male
Age at diagnosis: 18
SHOW TEXT VERSION
PRINT TRANSCRIPT
It was about August 2009 after I was eating food was coming back up, but I wasn’t making it. It was like as if it was coming back up, there was no retching or anything like that. I wasn’t putting my fingers down my throat, and it just started coming up. So obviously you know that’s not normal, so I went to the doctor and they started organising different tests for me, endoscopies, PH checkers to make sure everything was okay. But all this was taking months and months, and as it was going I was losing more and more weight and I was throwing up more, because I was trying to eat more to not lose weight. And after about ten months I’d lost about three stone so I’d gone down to about 7 stone and by that time it had gone from being you know something that was bothering me to my mind had changed to or you know this is good. 
 
I started becoming obsessed with exercising, exercising all the time, obsessing over food. You know calorie counting. And all the tests came back negative and they basically said you know, there is nothing physically wrong with you. And that’s when I started to you know he said but this just something you’ve got to tell your brain to stop doing this. That’s what, that’s what the doctor told me to do. 
 
By this time I was fuming. I was just an angry obsessed being basically. Hated everything. Angry at everyone. And I’d started doing a sports course at college, which I couldn’t, I shouldn’t have physically been doing because you know I was so hungry I couldn’t eat sleep half the time. But I was writing in that I was eating about 700 calories a day, and I was burning off probably about one and a half thousand calories a day through exercise, , and that doesn’t include like brain function calorie burning or anything like that. Just pure exercise. So I was getting lower and lower and I was so down like just wanted my life to end.
 


Last reviewed October 2018.

Copyright © 2024 University of Oxford. All rights reserved.